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Introduction. Most New Zealanders experience low back pain (LBP) at least once throughout their lifetime and many seek help from the large range of health providers in primary care. Accident Compensation Corporation (ACC) funds a significant proportion of those claims, but which services are they funding and what are the costs? Method. This was a retrospective audit and descriptive analysis of ACC-funded, non-public hospital healthcare service use by people with LBP in New Zealand (NZ). Outcome measures were the healthcare services accessed by people with ACC-funded LBP,the claims (all occurrences for a service that has generated a payment/ year), single contact (with a service), and costs (NZ$) for services between 2009 and 2020. Results. The number of claims for services were 129 000 for physiotherapy, 105 000 for general practitioner and 59 000 for radiology services. Per single contact, elective surgery and radiology services were the most expensive. During 2009-2020, there were 3.3 million ACC claims for LBP with a total cost of NZ$4 billion. Over this time, there was an increase in claims, costs and single contacts. Costs decreased slightly during 2010 due to changes in healthcare funding and in 2020 due to the COVID-19 pandemic. Discussion. Consumers have considerable choice in where they access health care for ACC-funded LBP services. This study shows the services they use most frequently and the cost to NZ for those services. These data can inform service planning for ACC-funded LBP health care in NZ.
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The prairie nymph, Herbertia lahue ssp. caerula, is a critically imperiled grassland plant in Mississippi. A large population of the prairie nymph occurs at the Vicksburg National Military Park. This population of prairie nymph occurs in a managed anthropogenic grassland with a host of associated native and exotic species. With the assistance of National Park Service staff an experiment investigating the effects of their mowing and a study of the growing conditions and pollinators of the plant was initiated. The mowing experiment was abandoned after two years because of the COVID-19 pandemic and yielded no significant results. Here we report on the growing conditions and associated species. The syrphid fly, Toxomerus marginatus, was observed to be a frequent flower visitor.
ABSTRACT
The prairie nymph, Herbertia lahue ssp. caerula, is a critically imperiled grassland plant in Mississippi. A large population of the prairie nymph occurs at the Vicksburg National Military Park. This population of prairie nymph occurs in a managed anthropogenic grassland with a host of associated native and exotic species. With the assistance of National Park Service staff an experiment investigating the effects of their mowing and a study of the growing conditions and pollinators of the plant was initiated. The mowing experiment was abandoned after two years because of the COVID-19 pandemic and yielded no significant results. Here we report on the growing conditions and associated species. The syrphid fly, Toxomerus marginatus, was observed to be a frequent flower visitor. © Copyright 2022 Southern Appalachian Botanical Society.
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The COVID-19 pandemic resulted in profound disruption to geography higher education. A pivot to online teaching required staff to rapidly adapt their practices to novel digital spaces. Whilst many studies have reported the different pedagogic approaches adopted, fewer have evaluated the resultant student learning experience. In this study, we aimed to create an evidence base regarding the benefits and challenges of online learning during the pandemic, mapped against the teaching, cognitive and social presences of the Community of Inquiry framework. We adopted a mixed-methods approach of online surveys (105 students) and focus groups (14 students), undertaken across two undergraduate geography programmes in a British university, exploring the benefits of asynchronous and synchronous online learning, and assessment and feedback strategies. We discovered flexibility in student work patterns and use of technology to facilitate engagement in learning. We also identified key challenges for students such as time management, maintaining motivation, engaging in online classes, and feeling part of an online learning community. We identify best practice in collaborative-constructivist online learning, so that in the event of any future remote pivot, or with sustained adoption of blended modes of delivery, we can achieve a high-quality student learning experience. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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Although higher education has engaged in blended learning since the early 1990s and its benefits are well catalogued, research often focuses on individual programmes and less on how institutions envision and engage with it to enhance learning and teaching. This article provides a pre-Covid 19 pandemic snapshot of cross-institutional UK policy and practice, through an interpretative, qualitative study of strategy documents and expert interviews. Findings show that while not prominent in pre-pandemic published institutional strategies, commitments to blended learning are expressed in terms of flexibility, inclusivity and accessibility, recognising the need for structures and support. Experts identify strategic leadership, governance structures, professional development and ongoing support as important requirements for large-scale adoption. The article concludes that blended learning, pre-pandemic, had not normalised. Post-pandemic, to normalise blended learning and support sustained widespread adoption, institutions should heed research literature recommendations and devise institutional visions that establish support, structure and shared strategy. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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The research focused on consumer perceptions of sustainability within the fashion industry and how influential education is in changing consumer habits and increasing the likelihood of sustainable consumption. The research, using a mixed-method approach, also asks what drivers are needed to support this transition. Using a quantitative survey widely distributed (varied sample) and qualitative semi-structured individuals with fashion students, results show that education on what sustainability means for fashion is largely gained through mainstream social media and documentaries with no formal compulsory education in place. It shows that many consumers saw sustainability as a motivating factor in purchasing;however, price was still a barrier for most. Respondents believed that intervention in school curricula was the best way to educate future generations about sustainability and that having the skills to maintain longevity in clothing use was a key factor to a more sustainable fashion future.
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Decolonization and Indigenization of k-12 schooling is pressing and important and must move forward within the significant challenges and unique circumstances of the COVID-19 pandemic. In this paper I share what I learned in partnership with school leaders about leading Indigenization in a global pandemic. Through findings from a design-based study I present the needs and challenges of school leaders and chronicle what school leadership looked like towards decolonization and Indigenization. I conclude with questions intended to inspire critical reflection and open up possibilities for educators, policy makers, and educational researchers leading this work in the ongoing pandemic and beyond.
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The perinatal period is a high risk for onset and relapse of mental health problems. The COVID-19 pandemic is a particularly stressful occurrence with reported negative impacts on perinatal mental health, hence the need to understand these impacts on pregnant and post-partum childbearing women and people, and prioritise interventions to alleviate them. This is the first of two articles. © 2022, All4Holdings Ltd. All rights reserved.
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Introduction: In the setting of viral infections, including infection with SARS-CoV-2, lymphocyte exhaustion and lymphopenia are common. Patients with COVID-19 who develop lymphopenia, particularly low numbers of circulating natural killer (NK) cells, are at high risk for disease progression. Thus, strategies that overcome profound lymphopenia and restore innate immune function may reduce the severity of COVID-19. One approach is the direct infusion of an exogenous source of healthy, functional NK cells intended to boost the patient’s immune system during the viral infection, enabling elimination of infected cells. “DVX201” is a cord blood-derived allogeneic NK cell therapy that is cryopreserved and intended for “off-the-shelf use” without HLA-matching. Objective: The primary objective of this study is to investigate the safety and to identify the recommended phase II dose and/or the maximum tolerated dose (MTD) of DVX201 in patients hospitalized with COVID-19. Methods: We are conducting an open-label, nonrandomized phase I safety and dose-finding (modified 3+3) study of DVX201 at three dose levels in patients hospitalized with COVID-19. Adult patients with documented SARS-CoV-2 infection were eligible if they were admitted to the hospital, were receiving ≤6 L supplemental oxygen by low flow delivery, and did not have other evidence of cytokine storm based on levels of serum IL-6, C-reactive protein, and ferritin. Results: To date, 9 patients have been enrolled: 3 subjects at each dose level. All dose levels have been well tolerated, with no dose-limiting toxicities, infusion toxicities, or cytokine release syndrome observed. All patients were discharged from the hospital at an average of 5 days post infusion. Blood samples were drawn for correlative studies including persistence of DVX201, pre- and post-infusion immune system characterization, and cytokine panels. Accrual is continuing at the MTD. Discussion: This trial will serve as the proof of concept for the use of DVX201 as an anti-viral treatment for COVID-19. These results will inform the potential role of DVX201 for treatment of other life-threatening viral infections by harnessing NK cells’ innate function to kill virally infected cells, regardless of the etiology of the infection.
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Background/Purpose: The craniofacial team meeting represents a critical timepoint at which a diverse group of disciplines assemble in quorum to discuss the complex medical and psychosocial issues facing their patients and create treatment plans to address them. Professionals from not only different disciplines but from entirely different fields must efficiently amalgamate their expertise to create one intricate plan for their unique patient population. It is this diversity of disciplines represented and the complexity of subject matter that makes craniofacial team meetings ideal for studying team functioning during multidisciplinary meetings. The global pandemic necessitated a shift of these complex meetings to the virtual setting. While providing direct patient care (i.e. tele-health) has been studied extensively, the literature on virtual team meetings is lacking. The authors of this study evaluated the team functioning of one craniofacial team by studying their virtual team meetings. Methods/Description: Ten virtual team meetings, including 94 patient case discussions, from a 3-month period in late 2020 were recorded and scored individually by three members of the research team using modified versions of the standardized multidisciplinary team Meeting Observational Tool (MOT) and the Metric of Decision-Making (MODe). The mean score amongst the three observers for each category of team functioning was used for analysis. Participants' subjective assessments of team meetings were elicited through monthly Qualtrics surveys. Results: Our results indicate that team functioning during virtual team meetings was high for providing case history, exhibiting optimal team behavior, and providing a treatment plan for individual case discussions. Patient-centered and psychosocial categories received lower scores. Survey respondents generally regarded their team as highly functioning during team meetings, with lower marks given only for decision-making efficiency and full participation from all disciplines. The meeting technology and equipment received a high score on average. Additionally, participants indicated that the virtual format did not enhance or hinder team functioning during team meetings. Conclusions: Amidst the ongoing COVID-19 pandemic it is important to study the effectiveness of multidisciplinary team meetings held in a virtual format. Our findings suggest that virtual setting allows for high team functioning as measured by both objective and subjective assessments and should therefore be considered a viable alternative to in-person meetings. The team performed best in discussing clinical topics, generating treatment plans, and team behavior, including equality among disciplines. Psychosocial matters and patient perspectives were not discussed as extensively as clinical topics and the team overestimated their coverage of both psychosocial matters and patient perspectives, consistent with previous studies on team functioning.
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Study Objectives: COVID-19 dramatically changed weekly academic conferences with virtual presentations replacing in-person didactics. Through group chat functions, modern communication platforms provide the opportunity for synchronous online discussions to occur in parallel with didactic presentations. We sought to qualitatively characterize the content, nature, and educational uses of synchronous online discussions occurring during weekly academic conferences and to assess the attitudes of lecturers and audience members towards these discussions. Methods: Transcripts of synchronous online discussions occurring from 7/1/20 to 12/31/20 were qualitatively analyzed using a grounded theory approach. Initial themes were identified by the primary author. Following a preliminary coding by the study authors, the themes were iteratively refined to arrive at a final coding strategy. Each month’s transcripts were coded by 2 study authors. When there was disagreement between coders, the primary author made a final coding determination. Following the study period, a survey distributed to residents and faculty assessed attitudes towards the synchronous online discussions. Results: The qualitative analysis of the transcripts identified 2352 coded messages. The final coding schema can be seen in Figure 1. Of 1720 identified content codes, the most commonly identified themes were cultural communications (40.8%) and knowledge sharing (39.0%). Within the broader theme of knowledge sharing, participants were most likely to share individual practice experience (366/671 codes). Statements with uncited data/evidence (113 codes) occurred in similar frequency to sharing of academic resources (137 codes). Questions directed towards other members of the audience (48.8% of questions) were only slightly less common than questions directed to the lecturer (51.2% of questions). There were 56 respondents to the survey (30 residents, 25 faculty, 1 fellow). Of the 44 respondents that had presented didactics, 54.5% (24/44) identified that it was challenging to keep up with the synchronous online discussion. From the perspective of the audience, 82.1% (46/56) felt it was easy to keep up with the discussion. Presenters of didactics felt identifying a member of the audience as a surrogate was the easiest means to keep up with the discussion (75%, 33/44 presenters). Audience members agreed that they were much more likely to ask a question in a synchronous online discussion as opposed to speaking out loud (71.4%, 40/56). Conclusions: Weekly academic conferences are a critical component of residency education, enabling not only the acquisition of knowledge but also the social sharing of knowledge/experiences developing of robust communities of practice. Our qualitative analysis found that cultural communication occurred with near equal frequency to knowledge sharing and that sharing of individual practice experiences was more common than sharing of academic resources. These synchronous online discussions may make it more likely for audience members to ask questions of each other or the lecturer but keeping up with the discussion was challenging for lecturers. [Formula presented]
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Background. Remdesivir (RDV) is a potent nucleotide prodrug inhibitor of the SARS-CoV-2 RNA-dependent RNA polymerase that has demonstrated efficacy in the treatment of patients hospitalized with moderate to severe COVID-19. This Phase 3 (GS-US-540-9012) double-blind, placebo-controlled study compared the efficacy and safety of 3 days of RDV to standard of care in non-hospitalized, high-risk participants with confirmed COVID-19. Methods. Participants were randomly assigned 1:1 to receive intravenous (IV) RDV (200 mg on day 1, 100 mg on days 2 to 3) or placebo. The primary efficacy endpoint was composite COVID-19 hospitalization or all-cause death by day 28 and compared using Cox proportional hazards model with baseline stratification factors as covariates. The primary safety endpoint was proportion of participants with treatment-emergent adverse events. Study enrollment was terminated early for administrative reasons in light of the evolving pandemic. Results. 562 patients underwent randomization and started their assigned treatment (279, RDV;283, placebo). Baseline demographics and characteristics were balanced across arms. Overall, 52% were male, 44% were Hispanic/Latino ethnicity and 30% were ≥ 60 years old. The most common comorbidities were diabetes mellitus (62%), obesity (56%;median BMI, 30.7), and hypertension (48%). Median baseline SARS-CoV-2 RNA nasopharyngeal viral load was 6.2 log10 copies/mL. Treatment with RDV significantly reduced COVID-19 hospitalization or all-cause death by day 28 (HR, 0.13;95% CI, 0.03 - 0.59;p = 0.008;Table 1) compared to placebo. Participants receiving RDV also had significantly lower risk for COVID-19-related medically attended visits or all-cause death by day 28 compared to placebo (HR, 0.19;95% CI, 0.07 - 0.56;p = 0.002;Table 1). No deaths occurred in either arm by day 28. There was no difference between arms in time-weighted average change in nasopharyngeal viral loads from baseline up to day 7. The proportion of patients with AEs was similar between arms (Table 1);the most common AEs in the RDV arm were nausea (11%), headache (6%), and diarrhea (4%). Conclusion. A 3-day course of IV RDV was safe, well tolerated and highly effective at preventing COVID-19 related hospitalization or death in high-risk non-hospitalized COVID-19 patients.
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Background: Individuals living in rural areas have higher obesity and obesity related co-morbidities than their urban counterparts. Understanding rural-urban differences associated with weight management may inform the development of effective weight management interventions for adults living in rural areas. Methods: The International Weight Control Registry (IWCR) is an online registry designed to assess factors contributing to successes and challenges with weight loss and weight loss maintenance across the world. We examined demographics, weight history and weight management strategies in a sample of urban and rural residents in the Midwestern U.S. (IA, IL, IN, KS, MI, MN, MO, ND, NE, OH, SD, WI). Participants were classified as rural or urban by the Rural-Urban Commuting Area Code. Analyses included Chi-square tests for proportions and independent t-test and Wilcoxon rank sum test for continuous variables. Results: The sample was 45% rural (n = 78 of a total N = 174) with a mean age of 50.3 years. Rural residents were more likely to be white, non-college graduates, and have lower family income compared with urban areas (p < 0.05). Rural and urban residents reported similar weight histories and strategies for weight management. Work-related physical activity was higher and weekday sitting time was lower in rural compared to urban residents (p < 0.01). These data could potentially be impacted by the relative number of residents working from home during COVID-19 (Urban: 59% vs. Rural: 37%, p < 0.05). Rural residents were more likely to report a lack of neighborhood walkability (p < 0.01) and healthy food availability (p < 0.05) compared with urban residents. Conclusions: These data suggest rural-urban differences in demographic characteristics, opportunity for leisure time physical activity, and the availability of heathy foods should be considered in the development of weight management interventions. The consistency of the observed findings will be evaluated at the regional, national and international levels as the size of the available sample in the IWCR increases.
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Multiple lines of evidence currently indicate that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) gains entry into human host cells via a high-affinity interaction with the angiotensin-converting enzyme 2 (ACE2) transmembrane receptor. Research has further shown the widespread expression of the ACE2 receptor on the surface of many different immune, non-immune and neural host cell types, and that SARS-CoV-2 has the remarkable capability to attack many different types of human-host cells simultaneously. One principal neuroanatomical region for high ACE2 expression patterns occurs in the brainstem, an area of the brain containing regulatory centers for respiration, and this may in part explain the predisposition of many COVID-19 patients to respiratory distress. Early studies also indicated extensive ACE2 expression in the whole eye and the brain's visual circuitry in aged humans. In this study we analyzed ACE2 receptor expression at the mRNA and protein level in multiple cell types involved in human vision, including cell types of the external eye and several deep brain regions known to be involved in the processing of visual signals. Here we provide evidence: (i) that many different optical and neural cell types of the human visual system provide receptors essential for SARS-CoV-2 invasion;(ii) of the remarkable ubiquity of ACE2 presence in cells of the eye and anatomical regions of the brain involved in visual signal processing;(iii) that ACE2 receptor expression in different ocular cell types and visual processing centers of the brain provide multiple compartments for SARS-CoV-2 infiltration;and (iv) of a gradient of increasing ACE2 expression from the anterior surface of the eye to the visual signal processing areas of the occipital lobe and the primary visual neocortex. A gradient of ACE2 expression from the eye surface to the occipital lobe may provide the SARS-CoV-2 virus a novel pathway from the outer eye into deeper anatomical regions of the brain involved in vision. These findings may explain, in part, the many recently reported neuro-ophthalmic manifestations of SARS-CoV-2 infection in COVID-19 affected patients.
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COVID-19 exposed the need to identify newer tools to understand perception of information, behavioral conformance to instructions and model the effects of individual motivation and decisions on the success of measures being put in place. We approach this challenge through the lens of serious games. Serious games are designed to instruct and inform within the confines of their magic circle. We built a multiplayer serious game, Point of Contact (PoC), to investigate effects of a serious game on perception and behavior. We conducted a study with 23 participants to gauge perceptions of COVID-19 preventive measures and quantify the change after playing PoC. The results show a significant positive change to participants' perceptions towards COVID-19 preventive measures, shifting perceptions towards following guidelines more strictly due to a greater awareness of how the virus spreads. We discuss these implications and the value of a serious game like PoC towards pandemic risk modelling at a microcosm level. © 2021 ACM.
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Presented here is a review of the status of facility instruments at the Large Binocular Telescope Observatory (LBTO). These include: the prime-focus optical Large Binocular Cameras (LBCs);optical Multi-Object Double Spectrograph (MODS) for imaging and spectroscopy;and the two LBT Utility Camera in the Infrared (LUCIs) for imaging and spectroscopy, which include the commissioning of the Single conjugated adaptive Optics Upgrade for LBT (SOUL). Recently, the Potsdam Echelle Polarietric and Spectroscopic Instrument (PEPSI), a fiber-fed high resollution optical echelle spectrograph with polarimetry capabilities, has transitioned from a Principal Investigator (PI) instrument to a facility instrument. We discuss the”binocular lifestyle” including the unique challenges of using LBT in three ways: Duplex mode, with identical configurations on both sides (effectively an 11.8 meter mirror);Fraternal Twin (same instruments with different configurations) or Mixed mode, (different instruments on each side) which gives observers two 8.4 meter telescopes to use;or 22.65 meters in interferometry (LBTI) mode. We also review recent changes in nighttime operations at the observatory in response to the COVID-19 pandemic and plans for the implementation of the Health and Instrument Performance plan for the Observatory (HIPO), a program to proactively monitor the health and stability of the facility instruments. © 2020 SPIE
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Aims/Objectives/Background Self-harm among adolescents is a major concern both because it gives rise to considerable distress and disruption in young people's lives and it commonly recurs. There are currently wide variations in the care of this group of patients and it is widely reported that their experience in the emergency department is poor. Young people who have self-harmed may differ from others attending the ED and we need to know more about these differences to inform ED care and potential improvements. The aim of this study was to establish the needs and expectations among children and young people in the ED and to increase the understanding of the specific needs of adolescents who self-harm through comparison with another patient group in the ED. Methods/Design We undertook a case-control study with adolescents attending for suspected fractures serving as the control group. Adolescents and their guardians were each given a questionnaire pack on arrival in ED, and again at least 2 hours later, thus capturing their expectations and pre-existing characteristics, and their experience. Trained research assistants were present in the ED seven days a week and covered 10 am till 10 pm. The study commenced in July 2019 and terminated early in March 2020 at the onset of the COVID 19 pandemic. Results/Conclusions Young people who had self-harmed had significantly higher mean dissatisfaction scores than those with suspected fractures. They also had higher mean levels of emotional and interpersonal difficulties and these were associated with higher dissatisfaction scores. This is the first case-control study to show that dissatisfaction with the ED is at least partly a function of the particular mental health problems suffered by adolescents who self-harm. This in turn provides initial clues to the particular needs of this group of patients in whom the current management is widely reported as inadequate.